Strategic Health Purchasing Progress Mapping in Cameroon: A Scoping Review

Area of Science:

• Health Policy and Systems Research
• Health Economics
• Public Health

Background:

• Low- and middle-income countries increasingly use strategic health purchasing (SHP) to improve health systems.
• Nationwide analysis of SHP activities remains limited in many contexts.
• Cameroon faces health sector challenges necessitating innovative financing approaches.

Purpose of the Study:

• To explore the scope and development of strategic health purchasing (SHP) in Cameroon.
• To identify existing SHP elements within Cameroon's health financing schemes.
• To analyze challenges and propose recommendations for effective SHP implementation.

Main Methods:

• Scoping review utilizing Arksey and O'Malley framework, modified by Levac et al.
• Data extraction from relevant SHP studies and documents focused on Cameroon (2000-2019).
• Analysis of identified SHP elements within existing health financing schemes.

Main Results:

• Five health financing schemes in Cameroon exhibit elements of SHP: national health insurance (NHI), performance-based financing (PBF), voucher systems, private health insurance, and mutual health organizations.
• Fragmentation of the health financing system due to multiple purchaser markets challenges the governance of purchasing.
• Misalignment of benefit packages causes population coverage gaps and overlaps; fragmented payment systems persist, with tentative harmonization in NHI and PBF.

Conclusions:

• Effective SHP in Cameroon requires defragmentation of schemes, robust oversight, and aligned provider payment methods.
• Addressing fragmentation and misalignment is crucial for promoting equity, efficiency, and quality in health services.
• Strategic health purchasing holds potential for Cameroon if systemic challenges in governance and financing are tackled.